\[\\[0.25cm]\]
While vaccines remain the best strategy to prevent COVID-19, recent evidence suggests monoclonal antibodies (nMABs) or antivirals could potentially benefit certain vulnerable populations before or after exposure to SARS-CoV-2, such as the unvaccinated or recently vaccinated high-risk patients.
With the recent roll out of nMABs and antivirals, there is an urgent need to for knowledge and understanding around the use of nMABs and antivirals in the treatment of patients with COVID-19, such as factors of relevance in determining nMAB and antiviral treatment and the impact of nMAB and antiviral treatment in the community and hospital settings.
This OpenSAFELY report..
The code and data for this report can be found at the OpenSafely antibody-and-antiviral-deployment repository.
Between 11-Dec-2021 and 23-Feb-2022, a total of 50,730 non-hospitalised patients registered at a TPP practice in England were identified as being eligible for receiving an antiviral or nMABs for treating COVID-19 (Figure 1). While the majority of these patients only belonged to one high risk cohort, 7,690 (15%) eligible patients had records indicating that they fell into multiple high risk cohorts (high risk cohort count range 1 - 6). Out of the 50,730 eligible patients, a total of 6,460 patients received an antiviral or nMABs (Figures 2 and 3);
Figure 1: Cumulative total of patients eligible for receiving an antiviral or nMABs for treating COVID-19 since 11th December 2021, stratified by high risk cohort. Patients are included as eligible on the date of thier positive SARS-CoV-2 test. Note, eligible patients can appear in more than one high risk group and the overall number (pre 10th February 2022) in each group is likely to be an overestimation due to including patients where their SARS-CoV-2 infection is confirmed by a lateral flow or polymerase chain reaction test.
Figure 2: Cumulative total of patients who received an antiviral or nMAB for treating COVID-19 since 11th December 2021, stratified by treatment type
Figure 3: Cumulative total of patients who received an antiviral or nMABs for treating COVID-19 since 11th December 2021, stratified by high risk cohorts. Note, treated patients can appear in more than one high risk group.
Figure 4: Weekly proportion of eligible patients receiving an antiviral or nMAB for treating COVID-19 since 11th December 2021, stratified by high risk cohort
| High risk cohort | Count | Count | % | Count (%) | Count (%) | Count (%) | Count (%) | Count (%) |
|---|---|---|---|---|---|---|---|---|
| All | 50730 | 6420 | 13 | 80 (1) | 3600 (56) | <5 | 2680 (42) | 50 (1) |
| Immune-mediated inflammatory disorders | 20390 | 3030 | 15 | 30 (1) | 1720 (57) | <5 | 1250 (41) | 20 (1) |
| Primary immune deficiencies | 9940 | 1190 | 12 | 20 (2) | 620 (52) | <5 | 540 (45) | 10 (1) |
| Solid cancer | 8370 | 950 | 11 | 10 (1) | 550 (58) | <5 | 380 (40) | 10 (1) |
| Rare neurological conditions | 5680 | 920 | 16 | 20 (2) | 480 (52) | <5 | 420 (46) | 10 (1) |
| Haematological diseases and stem cell transplant recipients | 4530 | 930 | 21 | 10 (1) | 520 (56) | <5 | 390 (42) | 10 (1) |
| Solid organ transplant recipients | 3490 | 860 | 25 | <5 | 560 (65) | <5 | 290 (34) | 10 (1) |
| Renal disease | 3160 | 800 | 25 | <5 | 540 (68) | <5 | 260 (32) | 10 (1) |
| Liver disease | 3130 | 320 | 10 | <5 | 170 (53) | <5 | 140 (44) | <5 |
| Down’s syndrome | 1090 | 150 | 14 | <5 | 50 (33) | <5 | 100 (67) | <5 |
| Immuosupression due to HIV or AIDS (CD4 <350 cells/mm3) | 330 | 190 | 58 | <5 | 70 (37) | <5 | 120 (63) | <5 |
| Group | Variable | Count | Count | % | Count (%) | Count (%) | Count (%) | Count (%) | Count (%) |
|---|---|---|---|---|---|---|---|---|---|
| Age band | 12-29 | 5050 | 550 | 11 | 10 (2) | 300 (55) | <5 | 230 (42) | 10 (2) |
| Age band | 30-39 | 6470 | 990 | 15 | 10 (1) | 570 (58) | <5 | 390 (39) | 10 (1) |
| Age band | 40-49 | 8390 | 1320 | 16 | 20 (2) | 750 (57) | <5 | 530 (40) | 10 (1) |
| Age band | 50-59 | 10050 | 1450 | 14 | 40 (3) | 820 (57) | <5 | 580 (40) | 10 (1) |
| Age band | 60-69 | 8740 | 1130 | 13 | 20 (2) | 640 (57) | <5 | 460 (41) | 10 (1) |
| Age band | 70-79 | 7330 | 760 | 10 | 10 (1) | 410 (54) | <5 | 340 (45) | <5 |
| Age band | 80+ | 4700 | 270 | 6 | <5 | 110 (41) | <5 | 150 (56) | <5 |
| Sex | Female | 28640 | 3810 | 13 | 70 (2) | 2170 (57) | <5 | 1550 (41) | 20 (1) |
| Sex | Male | 22090 | 2650 | 12 | 40 (2) | 1440 (54) | <5 | 1130 (43) | 30 (1) |
| Sex | Unknown |
|
|
|
<5 | <5 | <5 | <5 | <5 |
| Ethnicity | White | 40570 | 5480 | 14 | 100 (2) | 3090 (56) | <5 | 2240 (41) | 40 (1) |
| Ethnicity | Asian or Asian British | 2540 | 330 | 13 | <5 | 210 (64) | <5 | 120 (36) | <5 |
| Ethnicity | Black or Black British | 2030 | 190 | 9 | <5 | 100 (53) | <5 | 80 (42) | <5 |
| Ethnicity | Mixed | 670 | 80 | 12 | <5 | 40 (50) | <5 | 40 (50) | <5 |
| Ethnicity | Other ethnic groups | 830 | 90 | 11 | <5 | 40 (44) | <5 | 50 (56) | <5 |
| Ethnicity | Unknown | 4090 | 290 | 7 | 10 (3) | 130 (45) | <5 | 150 (52) | <5 |
| IMD | 1 most deprived | 10310 | 920 | 9 | 20 (2) | 530 (58) | <5 | 370 (40) | 10 (1) |
| IMD | 2 | 10000 | 1180 | 12 | 20 (2) | 650 (55) | <5 | 500 (42) | 10 (1) |
| IMD | 3 | 10340 | 1450 | 14 | 20 (1) | 800 (55) | <5 | 610 (42) | 10 (1) |
| IMD | 4 | 9720 | 1350 | 14 | 20 (1) | 770 (57) | <5 | 550 (41) | 10 (1) |
| IMD | 5 least deprived | 8970 | 1380 | 15 | 30 (2) | 760 (55) | <5 | 580 (42) | 10 (1) |
| IMD | Unknown | 1400 | 180 | 13 | <5 | 100 (56) | <5 | 80 (44) | <5 |
| Rurality | Urban - conurbation | 13660 | 1370 | 10 | 20 (1) | 770 (56) | <5 | 580 (42) | <5 |
| Rurality | Urban - city and town | 26040 | 3470 | 13 | 70 (2) | 1840 (53) | <5 | 1520 (44) | 30 (1) |
| Rurality | Rural - town and fringe | 5900 | 850 | 14 | 10 (1) | 520 (61) | <5 | 310 (36) | 10 (1) |
| Rurality | Rural - village and dispersed | 3790 | 590 | 16 | 10 (2) | 380 (64) | <5 | 200 (34) | 0 (0) |
| Rurality | Unknown | 1350 | 180 | 13 | <5 | 100 (56) | <5 | 80 (44) | <5 |
| Region | East Midlands | 9050 | 1060 | 12 | 20 (2) | 740 (70) | <5 | 280 (26) | 20 (2) |
| Region | East of England | 12000 | 2040 | 17 | 10 (0) | 1110 (54) | <5 | 890 (44) | 20 (1) |
| Region | London | 3210 | 420 | 13 | 10 (2) | 160 (38) | <5 | 250 (60) | <5 |
| Region | North East | 2730 | 320 | 12 | <5 | 240 (75) | <5 | 80 (25) | <5 |
| Region | North West | 5340 | 610 | 11 | 20 (3) | 300 (49) | <5 | 290 (48) | <5 |
| Region | South East | 3240 | 430 | 13 | 10 (2) | 240 (56) | <5 | 180 (42) | <5 |
| Region | South West | 5880 | 940 | 16 | 30 (3) | 440 (47) | <5 | 460 (49) | <5 |
| Region | West Midlands | 2080 | 250 | 12 | <5 | 200 (80) | <5 | 50 (20) | <5 |
| Region | Yorkshire and the Humber | 7140 | 400 | 6 | 10 (2) | 180 (45) | <5 | 210 (52) | <5 |
| Region | Unknown | 70 | 10 | 14 | <5 | 0 (0) | <5 | <5 | <5 |
| Autism | Autism | 300 | 40 | 13 | <5 | 20 (50) | <5 | 30 (75) | <5 |
| Care home | Care home | 1700 | 60 | 4 | <5 | 10 (17) | <5 | 50 (83) | <5 |
| Dementia | Dementia | 1230 | 50 | 4 | <5 | 10 (20) | <5 | 30 (60) | <5 |
| Learning disability | Learning disability | 1310 | 170 | 13 | 0 (0) | 60 (35) | <5 | 100 (59) | <5 |
| Serious mental illness | Serious mental illness | 700 | 70 | 10 | <5 | 30 (43) | <5 | 30 (43) | <5 |
| Housebound | Housebound | 1830 | 180 | 10 | <5 | 90 (50) | <5 | 80 (44) | <5 |
| CEV | CEV | 26850 | 4570 | 17 | 70 (2) | 2600 (57) | <5 | 1860 (41) | 40 (1) |
| Sickle cell disease | Sickle cell disease | 750 | 50 | 7 | <5 | 20 (40) | <5 | 20 (40) | <5 |
| Vaccination status | Un-vaccinated (declined) | 790 | 30 | 4 | <5 | 20 (67) | <5 | 10 (33) | <5 |
| Vaccination status | Un-vaccinated | 2310 | 120 | 5 | <5 | 60 (50) | <5 | 60 (50) | <5 |
| Vaccination status | One vaccination | 1580 | 130 | 8 | <5 | 70 (54) | <5 | 50 (38) | <5 |
| Vaccination status | Two vaccinations | 7330 | 520 | 7 | 10 (2) | 280 (54) | <5 | 220 (42) | 10 (2) |
| Vaccination status | Three or more vaccinations | 38720 | 5660 | 15 | 100 (2) | 3190 (56) | <5 | 2340 (41) | 40 (1) |
Of the 6460 patients who received treatment for COVID-19 between 11-Dec-2021 and 23-Feb-2022, 1,255 patients were missing records needed to confirm eligibility. It is likely that most, if not all, of these patients meet all of the eligibility criteria and non of the exclusion criteria but, for example, their SARS-CoV-2 test result was not available in their record or we just do not have access to all the criteria the clinician might use to assess high risk group status (such as the patients identified via non digital methods).
Figure 4: Breakdown of eligibility criteria variables in treated patients with missing records needed to confirm eligibility